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(_ ANOKA COUNTY <br />. Regional Economic Development <br />APPLICANT ACKNOWLEDGMENT: <br />I acknowledge the following: <br />• I am the property owner or co-owner, or a "member" of an ownership LLC for the <br />subject property. <br />• 1 am applying for a grant program that is supported through public funds. Names of <br />grant awardees, property address and dollar amounts will be publicly listed on the <br />Anoka County website and all submitted information will be subject to public record <br />requests if such a request were to be made. <br />• The subject property is current on all property tax and special assessment obligations. <br />The desired contractors identified above that will complete the requested work are <br />experienced, capable, and where applicable, licensed in their respective field. The <br />contract for services is between the contractor and the property owner, and Anoka <br />County assumes no liability for services provided. <br />• I, either personally or as a member of an LLC, do not have a majority ownership stake in <br />any of the identified contracting firms noted above. <br />Matt Rehbein <br />Name (printed) <br />f Signature�A�. <br />Submittal requirements: <br />Date: <br />S/3/23 <br />- Completed Application with signatures <br />- Municipal Acknowledgment <br />- Copies of bids/quotes for all chosen contractors, with primary contact indicated <br />- Additional supporting information that you feel would help in the review of the grant <br />application (optional) <br />All questions should be directed to Gregory Frahm -Gilles, Anoka County Director of Economic <br />Development, at Gregory.frahm-Mlles. co.anoka.mn.us or 763-324-4609. <br />Page 6 of 7 <br />